Testosterone, mood, behaviour and quality of life

Abstract

Testosterone plays a pivotal role in maintaining balance within the multi‐dimensional psychological network of mood, behaviour, self‐perception and perceived quality of life in men of any age. Apart from classical forms of hypogonadism, low testosterone concentrations can also be seen in older men, described as an age‐ and comorbidity‐driven functional hypogonadism and might relate to depressive symptoms exhibiting a wide array of clinical pictures ranging from dysthymia and fatigue over inertia, listlessness to hopelessness and suicidal thoughts. Also, various traits of anxiety, from unfocussed fear to phobic anxiousness and open panic syndromes, are influenced by testosterone. Correspondingly, anxiolysis is likely to be modulated by testosterone via stress resilience, threat vigilance and reward processing. The steroid modulates pro‐active and re‐active dimensions of aggression, which has to be seen within the context of gaining or maintaining status. This may also include other strategies impacting the social position: heroic or parochial altruism and non‐aggressive paths of assertiveness, such as posture and social vigilance. Independent rather than relationship‐associated self‐construal and self‐esteem influence risk‐taking traits under the modulation of testosterone. In addition, the genetic setting of the androgen receptor modulates the role of testosterone in aspects regarding mood and personality. Dimensions of sexuality are rather important in this context, but are not target of this article and covered in another part of this special edition. Overall, the quality of life in older hypogonadal men can be positively influenced by testosterone substitution, as has been demonstrated in large placebo‐controlled trials.

Symptom Profiles, Health-Related Quality of Life, and Clinical Blood Markers among Korean Community-Dwelling Older Adults Living with Chronic Conditions

“…The mechanism of higher symptoms burden in females is unclear. Studies have suggested that the role of gonadal sex steroids (e.g., estrogen, progesterone and testosterone) levels may influence their symptoms experiences [48][49][50]. Our study found that high sex hormones (free testosterone and DHEA) were significantly associated with the high HRQoL physical component in both the HSB and SDP subgroups but not in the PAF subgroup.…”

Late‐onset hypogonadism a challenging task for the andrology field

“…6 Conversely, the role of TRT in improving other LOH-related symptoms such as mobility and cognition impairment, as well as mood disturbances, is more conflicting. 7,8 Similarly, despite the fact that reduced T levels have been associated with worse metabolic profiles as well as with a higher cardiovascular (CV) risk, the current data only partially support the use of TRT for improving the latter conditions. 9,13 Finally, while TRT can contribute to the improvement of bone mineral density in osteoporotic subjects, its specific role in preventing bone fracture is unknown .…”

“…5 Specific papers included in this special issue analyzed all evidence-based data supporting the role of TRT on several outcomes. [5][6][7][8][9][10] In addition, available on-label and off-label TRT options have been specifically addressed and critically discussed. 11,12 Current evidence supports the role of TRT in improving sexual function in patients with a milder form of ED, whereas the effect of TRT in more complicated ED patients is less effective.…”

“…Current evidence supports the role of TRT in improving sexual function in patients with a milder form of ED, whereas the effect of TRT in more complicated ED patients is less effective 6 . Conversely, the role of TRT in improving other LOH‐related symptoms such as mobility and cognition impairment, as well as mood disturbances, is more conflicting 7,8 . Similarly, despite the fact that reduced T levels have been associated with worse metabolic profiles as well as with a higher cardiovascular (CV) risk, the current data only partially support the use of TRT for improving the latter conditions 9,13 .…”

“…Specific papers included in this special issue analyzed all evidence‐based data supporting the role of TRT on several outcomes 5‐10 . In addition, available on‐label and off‐label TRT options have been specifically addressed and critically discussed 11,12 .…”